Micobubbles - Maidstone Leads the World

Successful outpatient identification of the sentinel lymph node with ultrasound using microbubbles in breast cancer patients.

Sentinel lymph node (SLN) biopsy is a safe and accurate first line technique for staging the axilla in patients who have normal axillary lymph nodes on pre operative ultrasonography, with or without fine needle aspiration cytology (FNAC). Until now sentinel lymph nodes could only be identified at operation following injection of radioactive isotope and blue dye. This study was initiated to investigate the possibility that microbubbles injected into the breast would enable pre operative outpatient sentinel lymph node identification.

Methods
We recruited 70 consecutive consenting patients with primary breast cancer. Patients received a periareola intradermal injection of microbubble contrast agent. Breast lymphatics were visualised by ultrasound and followed to identify putative axillary SLN. Guidewires were deployed to localise this lymph node to determine whether it was the SLN at operation. The next day, patients underwent standard breast tumour excision and conventional SLN biopsy after administration of radioactive isotope and blue dye.

Results
In 61 patients, SLN were identified and guide-wires inserted. In these patients operative findings confirmed the wired lymph nodes (LN) were SLN. The sensitivity of SLN detection, by contrast enhanced ultrasound using microbubbles was 87%. A total of 11 patients were found to have metastases in SLN. In these patients the SLN were correctly identified and localised with guide-wires pre-operatively. In all metastatic cases, the sentinel lymph node seen by microbubble enhanced ultrasound and marked with a guidewire was involved.

Conclusions
The interstitial injection of microbubbles into the central part of the breast intradermally/subdermally is safe and well tolerated. This novel technique allows the sentinel lymph node to be readily identified before any surgery is undertaken. This will enable a targeted fine needle aspiration to be performed of the sentinel lymph node under ultrasound control and may reduce the need for a second operation in those who are sentinel lymph node positive.

Microbubble Enhanced Ultrasound Identification of Sentinel Lymph Node Presentation

To hear Mr Peter Jones' presentation to over 500 delegates at the Association of Breast Surgeons in York, May 2010 go to http://www.baso.org.uk/content/ABS-WebcastYork10.asp.

Then scroll to Section 4 "The Axilla"

"First Paper - Peter Jones. Click and Watch it Now"